5 Laws Anyone Working In ADHD Medication Pregnancy Should Know
ADHD Medication During Pregnancy and BreastfeedingThe decision to stop or continue ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There are few data on how long-term exposure may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders such as hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should weigh the benefits of taking it versus the risks for the baby. The doctors don't have the information to give clear advice however they can provide information on risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to make sure that the classification was accurate and to minimize any bias.
The study conducted by the researchers was not without its limitations. Researchers were unable, in the first place to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to the use of medication, or if they were affected by co-morbidities. Additionally the study did not examine the long-term outcomes of offspring.
The study found that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child from continued treatment for the woman's disorder. Physicians should discuss this with their patients and, when they are able, assist them in developing strategies to improve their coping abilities that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether or not to discontinue treatment during pregnancy is one that more and more doctors face. Most of the time, these decisions are made without clear and authoritative evidence regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests about the subject and their own judgments for each patient.
Particularly, the issue of potential risks for the baby can be tricky. The research on this issue is based on observation instead of controlled studies and the results are in conflict. In addition, most studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing the data from deceased and live births.
The conclusion is that while some studies have shown an association between ADHD medications and the risk of certain birth defects, others have found no connection, and most studies show a neutral or even slightly negative impact. In every case, a careful analysis of the potential risks and benefits is required.
It isn't easy, but not impossible for women with ADHD to stop taking their medication. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. Furthermore, a loss of medication can affect the ability to perform work-related tasks and safely drive which are essential aspects of a normal life for a lot of people with ADHD.
She suggests that women who are not sure whether to take the medication or stop it due to their pregnancy educate family members, coworkers, and acquaintances about the condition, its effects on daily functioning, and the benefits of continuing the current treatment plan. It can also help women feel more confident in her decision. It is important to note that some medications can pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be transferred to the infant.
Birth Defects Risk
As the use and use of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The researchers of the study did not find any association between early medication usage and other congenital anomalies, such as facial deformities or club feet. The results are in line with previous studies that showed an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women decide to stop taking their ADHD medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who needed help breathing at birth. However the researchers of the study were unable to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could have contributed to the findings.
Researchers hope that their study will inform physicians when they meet pregnant women. The researchers advise that, while discussing risks and benefits are important, the decision regarding whether here or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her needs.
The authors also warn that while discontinuing the medications is an alternative, it is not an option that is recommended due to the high incidence of depression and other mental health issues for women who are expecting or recently post-partum. Additionally, research suggests that women who stop taking their medication will have a harder adjustment to life without them after the baby is born.
Nursing
It can be a stressful experience becoming a mother. Women with ADHD who have to deal with their symptoms while attending physician appointments and preparing for the arrival of a baby and getting used to new routines at home can experience severe challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines pass through breast milk in low amounts, so the risk for infant who is breastfeeding is low. However, the frequency of medication exposure to the newborn may differ based on dosage, frequency it is administered and the time of the day it is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn infant is not fully known.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must weigh the benefits of keeping her medication against the possible risks to the embryo. Until more information becomes available, GPs can inquire about pregnant patients if they have a history of ADHD or if they intend to take medication in the perinatal period.
A increasing number of studies have shown that most women can safely continue taking their ADHD medication during pregnancy and while breastfeeding. As a result, more and more patients choose to do so, and in consultation with their doctor they have found that the benefits of maintaining their current medication outweigh any risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, and monitoring for indicators of deterioration, and, if necessary adjustments to the medication regimen.